Diffusely Calcified Long Lesion Treated Using Rotablation

- Operator : Jung-Min Ahn

Diffusely Calcified Long Lesion Treated Using Rotablation
- Operator: Jung-Min Ahn, MD
Case Presentation
A 70 years old female patient had surgery of rectal cancer, 6 months ago. At that time, Thallium SPECT as a pre-operation evaluation exam showed reversible perfusion defect at RCA territory. After the surgery, she had exertion of dyspnea. For correction of anginal symptom, coronary angiogram was done.
Baseline Coronary Angiogram
  1. The Right coronary angiogram showed significant stenosis at proximal to distal RCA with heavy calcification ( Movie 1).
  2. The Left coronary angiogram showed diffuse stenosis at proximal and mid LAD with heavy calcification and diffuse stenosis at proximal LCX and total occlusion at distal LCX ( Movie 2). FFR at pmLAD lesion showed 0.94 and 0.87 at pre-and post-hyperemia with adenosine, respectively.
Procedure
A 8 Fr sheath was inserted thorough the right femoral artery and right coronary artery was engaged with a 7 Fr JR 4 guiding catheter. The wire, 0.014-inch Sion was inserted into the RCA with help of Caravel micro-catheter. Pre-dilatation performed with a SAPPHIRE NC 2.5 x 18 mm balloon ( Movie 3). but it was failed due to calcified lesion. We decided to perform rotablation for calcified lesion and then inserted temporary pacemaker. A 0.014 inch Rotawire was placed into the RCA. Based on angiography image, we performed with a rotablator 1.25mm burr ( Movie 4). We changed a 0.014 inch Rotawire into a 0.014 inch BMW wire at RCA. Pre-dilatation at proximal to distal RCA with IKAZUKI 2.0 x 15 mm and SAPPHIRE NC 2.5 x 20 mm was performed ( Movie 5). After pre-dilatation, we deployed the Xience Alpine stent 2.5 x 38 mm at mdRCA ( Movie 6) and Xience Alpine stent 3.5 x 38 mm at pmRCA with help of Guide zilla 6Fr guide extension catheter ( Movie 7). Post-stenting adjunctive balloon dilatation with SAPPHIRE NC 3.5 x 15 mm was done. Final angiogram showed that the procedure was successful ( Movie 8).

Appendix
LAD IVUS image of post-rotablation ( Movie 9), post-stent ( Movie 10), and final image ( Movie 11)

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